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Review
. 2017 Jan 27;9(1):1-12.
doi: 10.4240/wjgs.v9.i1.1.

Perforated peptic ulcer - an update

Kin Tong Chung  1 , Vishalkumar G Shelat  1
Affiliations
Review

Perforated peptic ulcer - an update

Kin Tong Chung et al. World J Gastrointest Surg. .

Abstract

Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.

Keywords: Laparoscopy; Peptic ulcer; Perforation; Surgery.

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Figures

Figure 1
Figure 1
Computerized tomography scan shows free air under the diaphragm with peri-hepatic free fluid.
Figure 2
Figure 2
Erect chest X-ray image of the same patient with equivocal free air under the right hemidiaphragm.
Figure 3
Figure 3
Shows laparoscopic omental patch repair. A: Anterior duodenal perforation; B: Laparoscopic suturing; C: Omental patch; D: Abdominal drain placement.
Figure 4
Figure 4
Determinants of outcomes in patients with perforated peptic ulcer.
See this image and copyright information in PMC

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